Massive organ embolization from primary aortic thrombosis

Patrício, Catarina; Silva, Mariana Marques; Silva, Pedro Eduardo; Oliveira, João; Bagulho, Luís

doi:10.1016/j.repc.2017.02.020

Cited by 3 publications

(6 citation statements)

References 25 publications

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“…PAO clinical presentation is sudden and depends on the aortic occlusion level and thrombus localization. In our study, similarly to others [3,26,28,29], the majority of our patients (81.8%) were admitted to the Emergency Department with clinical signs and symptoms of acute onset of lower limb functional impotence, pain, hypothermia and ischemia. In these patients, the diagnosis can be suspected when the acute onset of lower limb symptoms is associated with the absence of femoral pulses, but in cases of paraplegia or sudden lower limb impotence, a correct differential diagnosis with neurological disease can be more complex and may delay the diagnosis.…”

Section: Discussionsupporting

confidence: 76%

“…Although any significant difference between male and female genders has never been reported in the literature [3], in our study, we found that there was a mild prevalence in males (male/female ratio: 2.66/1). The mean age of our population was 65.27 years old, slightly older than what has previously been reported (<50 years old patients mean age) [27][28][29].…”

Section: Discussioncontrasting

confidence: 58%

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Lower Limb Ischemia as Acute Onset of Primary Aortic Occlusion: CTA Imaging and Management

Lassandro¹,

Tamburrini²,

Liguori³

et al. 2023

IJERPH

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Primary aortic occlusion (PAO) is defined as acute occlusion in the absence of aortic atherosclerosis or aneurysm. PAO is a rare disease with acute onset and can determine massive parenchymal ischemia and distal arterial embolization. The aim of our study was to focus on the assessment of clinical characteristic, CT signs, medical and surgical treatment, complication rates and the overall survival of PAO. Materials and Methods: We retrospectively analyzed the data of all patients with acute lower limb ischemia and a final surgical or discharge diagnosis of PAO who underwent aortic CT angiography in ER settings in our hospital from January 2019 to November 2022. Results: A total of 11 patients (8 males/3 females; male/female ratio, 2.66:1, age range 49 to 79 years-old, mean age 65.27 y/o) with acute onset of lower limb impotence or ischemia were diagnosed with PAO. The etiology was thrombosis in all patients. The aortic occlusion was always located in the abdominal aorta and extended bilaterally through the common iliac arteries. The upper limit of the thrombosis was detected in the aortic subrenal tract in 81.8% of the cases, and in the infrarenal tract in 18.2%. A total of 81.8% of the patients were referred to the ER for symptoms related to lower limb: bilateral acute pain, hypothermia and sudden onset of functional impotence. Two patients (18.2%) died before undergoing surgery for multi-organ failure determined by the severe acute ischemia. The other patients (81.8%) underwent surgical treatment that included aortoiliac embolectomy (54.5%), aortoiliac embolectomy + aorto-femoral bypass (18.2%) and aortoiliac embolectomy and right lower limb amputation (9.1%). The overall mortality was 36.4% while the estimated survival at 1 year was 63.6%. Conclusions: PAO is a rare entity with high morbidity and mortality rates if not recognized and treated promptly. Acute onset of lower limb impotence is the most common clinical presentation of PAO. Aortic CT angiography is the first-choice imaging technique for the early diagnosis of this disease and for the surgical treatment, planning and assessment of any complications. Combined with surgical treatment, anticoagulation is considered the first-line medical therapy at the time of diagnosis, during surgical treatment and after at discharge.

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Section: Discussionsupporting

confidence: 76%

Section: Discussioncontrasting

confidence: 58%

Lower Limb Ischemia as Acute Onset of Primary Aortic Occlusion: CTA Imaging and Management

Lassandro¹,

Tamburrini²,

Liguori³

et al. 2023

IJERPH

View full text Add to dashboard Cite

show abstract

“…The surgical approach was only indicated for patients who do not respond to conservative treatment. 19 - 21 , 23 , 24 …”

Section: Resultsmentioning

confidence: 99%

“…Regarding the choice of anticoagulation drug, most studies used unfractionated heparin (UFH) for a short period of time and then switched to warfarin, 20 , 22 , 24 , 25 targeting an international normalized ratio (INR) between 2 and 3 20 , 25 or 2.5 and 3.5. 24 The duration of treatment remains uncertain and should be individualized, ranging from 4 months to lifelong for patients with a history of hypercoagulable state. 19 , 20 One patient was maintained on 100 mg aspirin alone after a warfarin regimen.…”

Section: Resultsmentioning

confidence: 99%

Mobile thrombus of the abdominal aorta: a narrative review

et al. 2022

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A primary aortic mural thrombus (PAMT) is defined as a thrombus attached to the aortic wall in the absence of any atherosclerotic or aneurysmal disease of the aorta or any cardiac source of embolus. It is a rare entity that has high morbidity and mortality. There is no consensus on the ideal treatment of PAMT. The objective of this paper is to review the possibilities for treatment of mobile abdominal aortic mural thrombus. Endovascular therapy and open surgery appear to be the best options for treatment of mobile abdominal aortic mural thrombus. Thus, in patients with favorable anatomy, endovascular therapy is probably the treatment choice, while in those with unfavorable anatomy, open surgery is probably the best option for treatment of a mobile abdominal aortic thrombus. It is important to emphasize that anticoagulation alone can be used as a non-aggressive option and, if this fails, endovascular or surgical methods can then be employed.

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“…But the risk of recurrent embolization was higher with the use of VKA; hence, many authors adopted an aggressive surgical or endovascular approach or combined hybrid approach in some of the cases where there was extensive thrombosis and risk of recurrent embolization was higher. 8 …”

Section: Short Communicationmentioning

confidence: 99%

Resolution of Primary Aortic Thrombosis after Dabigatran therapy—A New Hope for the Rare and Old Disease

Jariwala

Kale

2019

Indian Heart Journal

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The primary aortic thrombosis (PAT) is an uncommon noncardiac cause of distal peripheral embolization to lower extremities. Also, this condition develops in the absence of extensive atherosclerosis of aorta or abnormal dilatation like aneurysm of the aorta. In most of the cases, there was either no or minimal atherosclerosis of the aorta. The disease can involve any part of the aorta, but in most of the cases, the thoracic aorta below the origin of the left subclavian artery followed by the infrarenal portion of the abdominal aorta was the most common site of involvement. In our case, there was extensive thrombosis starting from the lower part of the thoracic aorta extending across both the renal arteries up to the aortic bifurcation without any underlying aortic pathology or hypercoagulable disease. There are no guidelines for the management of the PAT, but our experience is based on few case series, case reports, and meta-analysis where there are variable success rate using conservative medical management, endovascular procedure, or surgical thrombectomy. Vitamin K antagonist was the drug of choice in all the cases as a part of conservative medical management or used to prevent recurrence after the endovascular or surgical procedure. We present a case of PAT where the use of dabigatran leads to complete resolution and prevented the recurrence of the disease during two-year follow-up, which is the first and unique case report of the literature.

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Massive organ embolization from primary aortic thrombosis

Cited by 3 publications

References 25 publications

Lower Limb Ischemia as Acute Onset of Primary Aortic Occlusion: CTA Imaging and Management

Lower Limb Ischemia as Acute Onset of Primary Aortic Occlusion: CTA Imaging and Management

Mobile thrombus of the abdominal aorta: a narrative review

Resolution of Primary Aortic Thrombosis after Dabigatran therapy—A New Hope for the Rare and Old Disease

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